Overview – The Crisis in Medicare Home Health Coverage and Access to Care

Medicare Home Health Coverage, Legally Defined

Medicare Coverage for Home Care Is Based On a Need For Skilled Care – Improvement Is Not Required

Misleading and Inaccurate CMS Medicare Home Health Publications

The Home Care Crisis: An Elder Justice Issue

Beneficiary Protections Are Lacking In Home Health Provider Conditions Of Participation

Barriers to Home Care Created by CMS Payment, Quality Measurement, and Fraud Investigation Systems

Proposed CMS Systems Will Worsen the Home Care Crisis

A Further Examination of the Home Care Crisis: Published Articles and Statistical Trends

Strategic Plans to Address and Resolve the Medicare Home Care Crisis

Misleading and Inaccurate CMS Medicare Home Health Publications

Summary: Medicare home health coverage law is clear.[1] While the application of individual case facts to law is always open to interpretation, Medicare home health coverage law is not overly complicated. But the Centers for Medicare & Medicaid Services (CMS), the agency responsible for administering Medicare, continues to publish and communicate misleading and inaccurate statements about Medicare home health coverage. In turn, these actions by CMS perpetuate misinformation and confusion about home health coverage laws with the following:

Medicare contractors who are responsible for payment of Medicare claims;

Medicare certified home health agencies that deliver home health care services; and

Beneficiaries who need accurate information about the benefits they may qualify for under law.

In Part 4 of our Medicare home health Issue Brief Series, CMA discusses the Medicare home health coverage laws, the definition of home health aide services, and statements made by CMS that miscommunicate coverage.

Conclusion: The Medicare Home Health coverage law is clear. Medicare beneficiaries have a right to know what benefits the law allows and how to qualify for those benefits. CMS should correct its misleading and inaccurate publicized statements to assist Medicare payment contractors, home health agencies, and beneficiaries understand the legally authorized Medicare home health coverage.

Senate Plans to Vote to Gut Health Care Next Week - Act Now to Stop These Cuts!

The Senate bill is still a secret, but what we’ve learned isn’t good. Senate leadership is pushing for a vote by the end of next week. While some information about policy changes is leaking out, such as the Medicaid payment rates referenced below, the bill is still a secret – no text, no hearings, no public debate. Some lawmakers are taking it upon themselves to engage the public:

Senator Richard Blumenthal (CT) held his own hearing at the Connecticut state Capitol on Monday the 19th to highlight the lack of transparency; Center Executive Director Judith Stein testified at this hearing in opposition to the emerging Senate bill and the secret process.

The Medicaid cuts in the Senate bill will be worse than the House bill. The House bill would decimate Medicaid funding, but the Senate cuts could be even deeper over time. According to reports, the Senate bill would, as noted by the Center on Budget and Policy Priorities, “reportedly lower the annual increase in state Medicaid funding under a per capita cap to the general inflation rate starting around 2025, which is well below the House-passed bill’s already inadequate growth rate. That means states would have to absorb much deeper cuts in federal Medicaid funding over the long run than under the highly damaging House bill.”

Keep the pressure on. Despite this lack of transparency, the Senate intends to vote on their secret bill next week. Though this process has been shrouded in secrecy, one thing is crystal clear: Now is the time to make our voices heard and tell Congress to protect our care!

World Elder Abuse Awareness Day

Last week, Center for Medicare Advocacy Chiplin Senior Fellow Ben Belton participated in a 2017 World Elder Abuse Awareness Day (WEAAD) commemoration at the United Nations (UN) in New York. This year’s WEAAD theme, “Understand and End Financial Abuse of Older People: A Human Rights Issue” highlighted the need to protect older people from the devastating effects of financial exploitation.

According to the U.S. Department of Justice, nearly 1 in 10 older people are abused each year. Older people who experience abuse are more likely to suffer poor physical and mental health and have higher mortality rates. Elder financial mistreatment erodes an older person’s financial security and puts serious strain on critical public programs such as Medicare and Medicaid. According to the National Association of Adult Protective Services (NAPSA), nearly 1 in 10 victims will turn to Medicaid “as a direct result of their own monies being stolen from them.”

The Center has a long history of advocating for beneficiaries who rely on the strength of these programs and is pleased to continue the fight for elder justice. At the 2017 Voices of Medicare Summit, Center staff led a panel discussion to raise awareness about dangerous anti-psychotics given to nursing home residents, a lesser-known elder justice issue that does serious harm to the health and financial well-being of millions of older people.

The Center looks forward to engaging partners from across the country and globe who advocate for the human rights of older people.